Senate bills include ‘common sense’ mandates around PDMPs and e-prescribing

Provisions of two bills introduced in the Senate this week feature new requirements for prescription drug monitoring programs and e-prescribing—two long-overdue mandates that would assist with clinical decision support, according to a prominent drug safety researcher.

The Every Prescription Conveyed Securely Act, sponsored by Sens. Michael Bennet, D-Colo., Elizabeth Warren, D-Mass., Dean Heller, R-Nev., and Pat Toomey, R- Penn., would mandate electronic prescribing for controlled substances reimbursed by Medicare Part D beginning in 2020.

A second bill, known as the Comprehensive Addiction and Recovery Act (CARA) 2.0, builds on addiction treatment legislation passed in 2016. The new bill, introduced by another bipartisan group led by Sen. Rob Portman, R-Ohio, provides additional funding for opioid treatment and mandates the use of PDMPs across the country within one year after enactment, a provision that was removed from the 2016 legislation. 

Although far from a panacea for widespread opioid addiction, those technology-driven measures would close several loopholes that contribute to overprescribing.

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“It’s remarkable that in 2018 we’re not already at a point where controlled substances are exclusively prescribed electronically,” Caleb Alexander, M.D., co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins Bloomberg School of Public Health in Baltimore told FierceHealthcare.

Mandatory e-prescribing, which Alexander called a “common sense” intervention, was one of several recommendations outlined in a report released in October by Johns Hopkins and the Clinton Foundation. According to the report, only 1 in 5 providers were able to prescribe electronically and fewer than 15% of controlled substances were e-prescribed.

During a Senate Health, Education, Labor and Pensions Committee hearing on Tuesday, Warren argued e-prescribing would be “enormously valuable.”

“These are the prescriptions that are most likely to be misused or diverted, and yet we’re sending them to pharmacies on little pieces of paper,” Warren said, referring to opioid prescriptions.

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Alexander says data generated through PDMPs can play an integral role in clinical decision support. But he added that a lack of PDMP functionality with an EHR is a “nonstarter” for hospitals looking to avoid multiple logins. Several states, including Indiana and Michigan, have already launched initiatives to build PDMP access into hospital EHRs.

“I think we’ll get to the point where checking a PDMP is no more uncommon that checking a patient’s kidney function before prescribing blood pressure medicine,” he says.

But Alexander also cautions that the health IT enhancements, while important, shouldn’t be oversold.

“We don’t have an epidemic of forgery, let’s put it that way,” he says.